Tooth decay is prevalent among poor children


One-fourth of the nation’s children have 80% of the nation’s tooth decay, and most of them are underprivileged.

The simplicity of those numbers, from the U.S. Government Accountability Office, underscores the reality of dental care in this country but gives little hint at its ultimate effects.

Oral infection is the No. 1 chronic disease in children — five times more prevalent than asthma — and experts estimate that more than 50% of children will have some tooth decay by age 5.


“For those kids who are not getting care, the problems don’t go away, they just get worse,” says Dr. Paul Reggiardo, a pediatric dentist in Huntington Beach and public policy advocate for the California Society of Pediatric Dentistry. “There is no better predictor of future dental health than looking at past dental health. Those kids growing up who have had dental decay in the past are the most likely to have dental decay in the future.”

An earlier version of this story identified Dr. Richard Mungo as an associate professor at the USC School of Dentistry. He is a clinical instructor.

In one study, conducted in California, 54% of kindergarten-age children and 71% of third-graders were found to have or have had tooth decay; more than a quarter had untreated decay. Of those children, researchers found that 4% needed urgent dental care. Among the low-income children, 72% had a history of tooth decay.

And in a 2011 study in the Journal of Health Care for the Poor and Underserved, researchers found that, among more than 2,300 poor, migrant and minority children in Los Angeles County, 81% needed dental care.

Dentists say such scenarios can be found across the country.

The consequences can be severe. Children rely on their upper front teeth to learn how to form words such as “the” and “two.” If the front teeth are decayed so badly that they have to be extracted, speech development can be severely impaired, says Dr. Richard Mungo, a Huntington Beach pediatric dentist and a clinical instructor at the USC School of Dentistry. And nutritionally, if children cannot chew and swallow properly because of sore teeth, they will choose soft, mushy foods like bread rather than meat and other protein sources.

“So it alters their entire nutritional intake,” says Mungo.

Further, numerous studies show that tooth pain is a major cause of missed school days and can lead to delayed learning and poor performance in school.

School nurses will tell you that many of the complaints they receive are dental-related, says Mungo, who is also vice president of the board of directors for Healthy Smiles for Kids of Orange County. That organization provides dental care and education for underserved and disadvantaged children.


“They get to school, and — if you’ve ever had a toothache, you really can’t concentrate on anything. So these kids can’t learn in school.”

Barriers to care

Untreated tooth decay can be blamed largely on lack of access to care, lack of awareness about the importance of good oral health, and the fact that many dentists don’t, or can’t afford to, treat families with Medicaid coverage.

That coverage is meant to aid the very poor, but Medicaid reimbursements don’t fully cover providers’ costs, and in many cases, Medicaid does not cover certain procedures. Further, Medicaid clinics have a high rate of no-shows — a direct result of economic barriers such as lack of reliable transportation and baby-sitters.

“I don’t think dentists want to become rich over this community,” says Dr. Indru Punwani, professor and head of the department of pediatric dentistry at the University of Illinois at Chicago. “But they have to pay their bills. And the reimbursement levels are way, way lower than the costs of care.”

Further, dentists who do provide the services free of charge, or nearly free, can become frustrated when patients don’t show up or when they fail to return for the necessary follow-up care. “Some of those are the barriers that lead to neglect,” says Punwani.


Says Mungo: “It’s amazing how many kids have never had an eye exam or never had a dental exam and they’re 5 and 6 years old.”

He spends his Fridays in the operating room at Children’s Hospital of Orange County — shoring up decayed teeth when possible, removing them when not — and says his oldest patients are typically only 18 months old and already have severe decay. It’s not uncommon to have to put these patients to sleep in order to do tooth extractions and multiple fillings, says Mungo. Often, these are children who have gone to bed with a bottle of milk or formula since they were infants.

“Baby falls asleep, bottle falls out, but the milk turns to lactic acid and that starts to eat away at the teeth,” he says.

Such problems may be especially common among the poor, but poor dental health in children transcends social and economic boundaries. Mungo sees plenty of children from affluent families as well; some may develop poor habits at daycare or have parents or caregivers who put them to bed with a bottle or allow them to eat sugary foods throughout the day.

Working for change

Some programs are working to turn the tide and meet the needs of poor families without dental care, including Healthy Smiles for Kids of Orange County and Smile for a Lifetime, a national charitable organization that provides free orthodontic care for underprivileged children.


Healthy Smiles focuses not just on treatment, but also on educating parents and children about oral health in order to prevent the cavities in the first place.

“We can’t really treat our way out of this problem — we’re never going to get done filling all the cavities and taking care of all these problems,” says Mungo. “So what we really have to do is work on the education and the prevention.”

The importance of education and awareness in changing the course of a child’s future oral health cannot be overstated, says Dr. Warren Brill, a pediatric dentist in Baltimore and clinical associate professor at the University of Maryland Dental School.

“Even those youngsters that would ordinarily be in the high-risk population, by the parents bringing them in and establishing the dental home early on, they learn what to do and not to do for their children,” says Brill. “I find that when the parents have the opportunity to learn these things, they latch right onto it.”